1. Field of the Invention
This invention relates generally to blind intubating devices, and more particularly to an esophageal tracheal intubator airway device that is placed in the oropharynx of a patient and seals around the laryngeal opening to prevent obstruction of the patient's airway and allow immediate ventilation of the lungs, passage of an endotracheal tube into the trachea, stomach suctioning, and fiberscopic examination of the upper respiratory and upper gastrointestinal tracts.
2. Brief Description of the Prior Art
If a patient is unconscious, either during general anesthesia or for any other reason, it is the first responsibility of the anesthesiologist or emergency medical provider to ensure adequate spontaneous or controlled ventilation of the patient through an unobstructed airway. Face mask ventilation with "chin lift" and "jaw thrust" maneuvers, oral airways, and laryngeal mask airways are used frequently for ventilation, and prevent the tongue and soft tissues of the throat from falling backward and obstructing the patient's airway.
Brain, U.S. Pat. Nos. 4,509,514, 4,995,388, and 5,297,547 disclose laryngeal mask airway devices which are conduits that are inserted into the throat and when properly positioned, terminate at the laryngeal inlet, thereby preventing the tongue and soft tissues of the throat from falling backward and obstructing airflow to and from the patient's lungs.
Unconscious patients who are believed to be at increased risk of vomiting and pulmonary aspiration (i.e. full stomach, gastroesophageal reflux, obesity, pregnancy, code situations), however, need more airway protection. A cuffed endotracheal tube is considered to be the best airway in this regard because the inflatable cuff forms a seal between the airway tube and the inside of the trachea, preventing any vomitus or secretions from passing around the tube and into the patient's lungs.
Endotracheal intubation is frequently performed by means of direct laryngoscopy. The practitioner extends the head of the patient on the neck, places the laryngoscope into the mouth, pulls the tongue and soft tissues up and out of the way to expose the larynx, and places the endotracheal tube through the larynx and into the trachea. Phillips, U.S. Pat. No. 3,856,001 discloses a typical illuminated laryngoscope blade used to pull the tongue and soft tissues up and out of the way to allow insertion of an endotracheal tube under direct vision.
Some patients, however, cannot be intubated by this method because of poor mouth opening, decreased neck mobility, or other anatomical abnormalities, but must have rapid establishment of an airway and suctioning of gastric contents. Various blind devices can be used to intubate such patients who cannot be intubated by direct laryngoscopy.
Kruger, U.S. Pat. No. 4,612,927 and Frankel, U.S. Pat. No. 4,825,858 disclose intubating guide and conduit devices which, when placed into the esophagus, allow tracheal intubation via positionally related portions of the above guides and conduits. They do not accommodate for the wide anatomical variations in distance between the larynx and esophagus, nor do they allow ease of tube placement, visual confirmation of tube placement, or ventilation during the process of intubation.
Frass, U.S. Pat. No. 4,688,568 discloses a combination (double lumen) tube which may be used for ventilation and stomach suction. These types of devices have many limitations. For example, they cannot be used in short, young patients, they are bulky and clumsy, do not always allow suction catheters to be passed through both lumens, create initial ambiguity over which lumen has gone where, are not as protective against secretion aspiration as standard endotracheal tubes, and are to be used only in emergency situations.
Laryngeal mask airways, as decribed above allow rapid ventilation, and can be used as conduits for endotracheal intubation, such as that disclosed in Brain, U.S. Pat. No. 5,303,697. All of these devices, however, have shortcomings in the areas of placement, ventilation, and endotracheal intubation. For example, the tip of the laryngeal mask airway will often curl over on itself, or impinge on the tip of the epiglottis and bend it posteriorly, both of which prevent proper placement of the laryngeal mask airway over the laryngeal inlet. Also, the tip of the epiglottis may obstruct the lumen of the laryngeal mask airway and prevent adequate ventilation and intubation. In addition, the bands at the entrance to the laryngeal mask airway severely limit the size of the endotracheal tube that can be placed through it. Lastly, once the endotracheal tube is placed in the trachea, the laryngeal mask airway must be gently pulled out around the tube while maintaining its position in the trachea, which requires additional time and manipulations.
Other devices for rapid blind endotracheal intubation are known. Parker, U.S. Pat. No. 5,174,283 discloses an anatomically contoured guide element which is supposed to align itself about and atop the patient's larynx, allowing subsequent intubation. However, this device would be unusable in many patients because of the very wide range of anatomic variations between patients, particularly in epiglottis length and laryngeal shape and size. Also, this device does not provide a seal around the larynx to allow positive pressure ventilation without endotracheal intubation.
The present invention overcomes these problems and is distinguished over the prior art in general, and these patents in particular by an esophageal tracheal intubator airway device which allows rapid blind access to the larynx and esophagus of a patient for lung ventilation, stomach suctioning, fiberscopic examination of the upper respiratory and upper gastro-intestinal tracts, and passage of an endotracheal tube into the trachea. The device has a conical positioning element which conforms to the base of the throat beneath the epiglottis and an elongate tubular esophageal conduit which extends through the positioning element and rearwardly therefrom in an arcuate curve. The esophageal conduit is sized to allow passage of a gastric suction tube and related medical instruments therethrough into the patient's esophagus. A laryngeal channel extends inwardly from the positioning element proximal end and curves outwardly to define an opening through the side wall of the positioning element. The channel is sized to allow passage of a cuffed endotracheal tube and related medical instruments therethrough into the patient's larynx and trachea. An inflatable tubular member or ring secured to the positioning element side wall surrounds the opening and when inflated, forms a sealing relation around the patient's laryngeal inlet while causing the positioning element to back out relative to the throat a sufficient distance for a lip at its proximal end to lift the tip of the epiglottis up and out of the way of the side wall opening.